mmpc - National Indian Health Board

Findings
Table 10. Unadjusted Mean Fee-for-Service payments per IHS AIAN Recipient for Outpatient Visit, Laboratory, Imaging and
Dental services.
Outpatient Visit, Laboratory, Imaging, and Dental* Payments per IHS AIAN Recipient
Group 1.IHS Program claims
& Active User
IHS Program
All Providers Providers* All Providers
28
Group 2.IHS Program claims
but Not Active User
IHS Program
Providers*
IHS Area Unadjusted Mean Payments Difference Unadjusted Mean Payments Difference
Aberdeen $ 2,045 $ 1,330 $ 715 $ 1,471 $ 1,045 $ 426
Alaska $ 2,554 $ 554 $ 2,000 $ 2,140 $ 387 $ 1,753
Albuquerque $ 2,124 $ 1,191 $ 933 $ 1,453 $ 974 $ 479
Bemidji $ 2,437 $ 592 $ 1,845 $ 2,417 $ 1,105 $ 1,313
Billings* $ 1,202 $ 2,039 $ (837) $ 1,202 $ 1,724 $ (521)
California $ 2,026 $ 1,397 $ 629 $ 1,882 $ 1,052 $ 830
Nashville $ 1,688 $ 842 $ 846 $ 2,351 $ 530 $ 1,821
Navajo $ 4,827 $ 3,340 $ 1,486 $ 2,200 $ 2,200 $ -
Oklahoma $ 1,854 $ 943 $ 910 $ 1,935 $ 918 $ 1,017
Phoenix $ 6,892 $ 4,102 $ 2,790 $ 4,841 $ 3,318 $ 1,523
Portland $ 1,963 $ 1,791 $ 173 $ 1,809 $ 1,356 $ 453
Tucson $ 7,588 $ 3,470 $ 4,118 $ 6,143 $ 3,769 $ 2,374
Area Mean $ 3,100 $ 1,800 $ 1,300 $ 2,487 $ 1,530 $ 956
Recipients in Medical Comprehensive Managed Care Plans (CMCP)
Age, Sex, Disability & Morbidity Do Not Explain Differences in Payments for Recipients with
Managed Medical Care
If left unadjusted for any determinants, the mean total payment for IHS AIAN recipients with capitated medical
care in a Comprehensive Managed Care Plan (CMCP) who are less than 65 years of age is slightly higher for
Whites ($4,268 compared to $3,865, or about $400 difference), but substantially higher for Other AIAN ($3,426,
or $842 difference) (Figure 11). The minimal actuarial adjustment for age and sex differences increases the
difference in payments between IHS AIAN and Whites ($6,273 compared to $5,265, or about $1,000) but not
with Other AIAN ($6,273 compared to $5,398, or about $875). As with the FFS recipients not in CMCP plans, this
effect is expected because the IHS AIAN have a younger age distribution than that of Whites and therefore lower
expected payments, but a similar age distribution to that of Other AIAN and therefore similar expected
payments. Again, the mean adjusted payment increases for all three groups with the age adjustment because
payments for older more costly recipients are given equal weight with less costly younger recipients which
constitute the vast majority of the recipients in all three groups. This is how the statistical adjustment controls
for the differences in age distributions across the three groups.
Adjusting payments further for disability status, either because of Medicaid eligibility as a disabled enrollee, or
as a Medicare-Medicaid ‘Dual’ enrollee under age 65, increases the adjusted means but not the differences in
means for the groups (Figure 11). The mean total payment for IHS AIAN is about $1,000 higher for Whites
($7,439 compared to $6,490) and for Other AIAN ($6,479). Again the adjusted mean rises for all groups
because the higher payments for the smaller groups of Disabled are given equal weight with less costly but
higher proportions of non-disabled recipients during the statistical adjustment.